Thrombocytopenia in Infants and Children

Thomas Jefferson University, Philadelphia, PA, USA.
Pediatrics in Review (Impact Factor: 0.82). 04/2011; 32(4):135-49; quiz 150-1. DOI: 10.1542/pir.32-4-135
Source: PubMed


• Thrombocytopenia should be suspected in any child presenting with a history of easy bruising or bleeding or petechiae, but it also may present as an incidental finding in an asymptomatic individual. • Thrombocytopenia may be caused by either increased destruction or removal of platelets from the circulation or decreased production of platelets. • Destructive mechanisms resulting in thrombocytopenia include immune-mediated destruction, platelet activation and consumption, mechanical platelet destruction, and platelet sequestration or trapping. • Impaired platelet production may be due to bone marrow infiltration, suppression, or failure or defects in megakaryocyte development and differentiation. • A thorough history and physical examination and judicious use of laboratory testing can lead to the appropriate diagnosis in most patients who have thrombocytopenia. • Childhood ITP generally presents with the sudden appearance of bruising, bleeding, or petechiae in an otherwise healthy child. • The diagnosis of ITP can be made using two criteria: 1) isolated thrombocytopenia with otherwise normal blood counts and peripheral blood smear and 2) no clinically apparent associated conditions that may cause thrombocytopenia. • Further evaluation, including bone marrow assessment, should be considered in patients who have atypical clinical or laboratory features at presentation; thrombocytopenia lasting more than 6 months; or a subsequent clinical course that is inconsistent with the natural history of ITP, including failure to respond to usually effective therapies. • Management of thrombocytopenia should be guided by an understanding of its cause and clinical course, with the principal goal in all patients being to maintain a safe platelet count to prevent significant bleeding. • For childhood ITP, pharmacologic intervention, including corticosteroids, IGIV, and anti-Rho(D) immune globulin, has been shown to raise the platelet count more quickly than no therapy and is recommended for children who have or at risk for severe or life-threatening bleeding, based on strong evidence. • ITP in children usually is short-lived, with at least two thirds of patients making a full and sustained recovery within 6 months of presentation, with or without treatment.

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    ABSTRACT: Thrombocytopenia is the result of falling the number of platelet from 150,000/microL. There are three main reasons of thrombocy-topenia, a-Decreasing of making platelet b-Increasing of destruc-tion platelet c-Changing of distribution platelet. Pseudothrombo-cytopenia must be kept in mind too. Both hereditary and acquired reasons help thrombocytopenia have wide spreaded, but acquired causes are more common with increasing age. Thrombocytopenia separates three stages as numerical. Mild: 100,000 -150,000/mi-croL, Moderate: 50,000 -100,000/microL. Severe: < 50,000/mi-croL. However, thrombocytopenia is not usually detected clinically until the platelet count has fallen to levels below 100,000/microL. Severe thrombocytopenia, such as intracerebral and intra-abdomi-nal bleeding may be life threatening. So diagnosing the treatment immediately can save the life. Transfusion of platelet may not need in all thrombocytopenias. Treatment of the underlying disease may be sufficient. The reason of thrombocytopenia can be temporary but also can be caused severe diseases. Causes of thrombocytopenia change development levels of countries, according to geographical distribution and application centers. In this review we emphasize common etiologies seen in adult patients with thrombocytopenia.
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